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Nov. 17, 2010 -- An international survey shows that the U.S. leads the industrialized world in out-of-pocket medical expenses and lack of access to medical care due to costs.

Americans were more likely than people living elsewhere to report having trouble paying medical bills and going without needed medical care because it was too expensive.

Satisfaction with health care was not much higher for insured Americans than for those without insurance, according to the survey by the health care research and advocacy group Commonwealth Fund.

Dissatisfaction with insurance was higher in the U.S. than anywhere else.

Almost a third of those surveyed in the U.S. said they spent a lot of time dealing with health insurance paperwork or that their insurance denied claims or paid less than anticipated for a doctor’s visit, hospital stay, or procedure.

The survey included close to 20,000 adults living in the U.S., U.K., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and Switzerland.

After the U.S., the countries with the next highest dissatisfaction with health insurance were Germany and France, with 23% of respondents reporting problems. The country with the least dissatisfaction was Sweden, with 4% of those surveyed finding fault with their health insurance.

Among the other major findings:

One in five adults in the U.S. said they had major problems paying medical bills, compared to about one in 10 people in France, 4% of people in the Netherlands, 3% of people in Germany, and just 2% of people in the U.K.

35% of U.S. respondents reported paying $1,000 or more out of pocket over the past year in medical bills, compared to 25% of those surveyed in Switzerland, 21% in Australia, and 4%, 2% and 1%, respectively, in France, Sweden, and the U.K.

Nearly half (46%) of working-age Americans with below-average incomes who were insured said they went without needed medical care due to cost and one-third said they had problems paying medical bills. Half as many Americans with above-average incomes said they had trouble paying their health bills.

Medicare Recipients Happier

Older Americans receiving Medicare were far less likely to report problems with their health care coverage than younger ones.

In an interview with WebMD, Cathy Schoen, MS, of the Commonwealth Fund said this is probably because older people don’t have to worry that they will lose their coverage.

“Medicare recipients have stable coverage. Once someone turns 65 they’ve got it and can’t lose it,” she says. “Right now there is a great deal of fear among insured younger Americans that if they lose their jobs they will lose their coverage.”

Americans were among the most concerned of all survey respondents that they would not receive the best treatment or be able to afford it if they became seriously ill.

In a news conference, Commonwealth Fund president Karen Davis predicted that these concerns will decline as health care reforms are implemented.

Will Health Care Law Improve Satisfaction?

While some of the reforms passed by Congress and signed into law by President Obama last spring are in effect, many of the most far-reaching will not kick in until 2014, including a Medicaid expansion that is projected to extend coverage to 16 million low-income people.

Other provisions of the law include prohibiting lifetime and annual caps on health care payouts and providing affordable options to people who lose their health insurance when they lose their jobs.

“We may see some improvement in satisfaction earlier, but big differences are not likely to show up until 2015 or 2016,” she says.

But it remains to be seen if lawmakers will fully fund the new law, and if Americans will embrace the health care changes if they do.

A poll conducted by Associated Press six months after the law’s passage found that a large percentage of Americans have only a very vague idea of what is in it.

Three out of 10 people polled said they favored the new law, while four out of 10 said they opposed it.

Schoen tells WebMD she’s confident the reforms will be popular once they are implemented.

“There is already broad support for allowing young adults to stay on their parents’ policies,” she says. “I predict there will also be broad support for removing annual limits on insurance payouts, which people often don’t know they have, and for assistance to help people afford health insurance if they don’t have employer coverage.”